Feigenberg Zvi
Medical Division, Magen David Adom, Israel.
Harefuah. 2010 Jul;149(7):413-7, 483, 482.
This article deals with the pre-hospital medical treatment provided by Magen David Adom (MDA) teams to the victims of 36 multi-casualty incidents caused by suicide bombers during the Al-Aksa Intifada. A total of 2048 people were injured in those 36 incidents--an average of 57 injured per incident. The data collection and analysis is based on operational and medical debriefing performed after each incident, with the participation of all MDA teams that treated and evacuated injured that were defined as urgent. The medical debriefing focused on: triage--the definition of the injured situation: urgent or not urgent, priority for treatment and priority for evacuation; the Level of treatment--advanced life support (ALS) (paramedics and physicians) in comparison with basic life support (BLS) [medics]; life saving procedures performed on the scene; and the way in which the teams on the scene decided on the hospital in the region to evacuate the injured.
MDA forces amassed [average per incident)--42 ambulances and 116 health providers. The timetable from the time of the explosion (average per incident] included: arrival of first ambulance--3.9 minutes and the evacuation of the first urgently injured from scene--10.7 minutes. The evacuation of the last urgently injured from the scene was 25.2 minutes.
Triage data showed that: 70% of the injured defined on the scene as urgent had a moderate--ISS > 9, or severe ISS> 16 injury. Life-saving procedures were performed on the scene on 99 victims [24% of all injured defined as urgent by MDA teams). Findings on decision-making regarding which hospital to evacuate the urgently injured revealed: 9 incidents took place in regions where Level 1 trauma centers were not available--all urgently injured were evacuated to regional hospitals, 63% of these patients were secondarily transferred to a Level 1 trauma center. In 27 incidents--one or more Level 1 trauma centers were available in the region and 71% of the urgently injured were transported directly from the scene to Level 1 trauma centers. Only 12% of those transported to regional hospitals were secondarily transported to Level 1 trauma centers. Even in multi-casualty incidents caused by explosions of suicide bombers, incidents that are characterized by stress, confusion and chaos--MDA teams succeeded in organizing the medical activity on the scene, acted professionally and provided medical treatment to those who were severely injured. This pre-hospital performance of MDA teams had a significant contribution to the successful treatment of the victims of those events by the entire trauma system in Israel.
本文探讨了在阿克萨起义期间，红色大卫盾组织（MDA）团队为自杀式炸弹袭击造成的36起多人伤亡事件的受害者提供的院前医疗救治情况。在这36起事件中，共有2048人受伤，平均每起事件有57人受伤。数据收集和分析基于每次事件后进行的行动和医疗汇报，参与救治和疏散被定义为紧急情况的伤者的所有MDA团队都参与其中。医疗汇报的重点包括：分诊——确定伤者情况：紧急或非紧急、治疗优先级和疏散优先级；治疗水平——高级生命支持（ALS）（护理人员和医生）与基本生命支持（BLS）[医护人员]的比较；在现场实施的救生程序；以及现场团队决定将伤者疏散到该地区哪家医院的方式。
MDA部队（平均每起事件）集结了42辆救护车和116名医护人员。从爆炸发生时起的时间表（平均每起事件）包括：第一辆救护车到达——3.9分钟，第一名紧急伤者从现场疏散——10.7分钟。最后一名紧急伤者从现场疏散的时间为25.2分钟。
分诊数据显示：在现场被定义为紧急情况的伤者中，70%有中度——损伤严重度评分（ISS）>9，或重度ISS>16损伤。在99名受害者（MDA团队定义为紧急情况的所有伤者中的24%）身上在现场实施了救生程序。关于将紧急伤者疏散到哪家医院的决策结果显示：9起事件发生在没有一级创伤中心的地区——所有紧急伤者都被疏散到地区医院，其中63%的患者随后被转至一级创伤中心。在27起事件中——该地区有一个或多个一级创伤中心，71%的紧急伤者从现场直接被送往一级创伤中心。被送往地区医院的伤者中只有12%随后被转至一级创伤中心。即使在自杀式炸弹爆炸造成的多人伤亡事件中，这类以压力、混乱和无序为特征的事件——MDA团队也成功地组织了现场医疗活动，专业地采取行动并为重伤者提供了医疗救治。MDA团队的这种院前表现对以色列整个创伤系统成功救治这些事件的受害者做出了重大贡献。
